What do older adults with multimorbidity and polypharmacy think about deprescribing? The LESS study - a primary care-based survey

Abstract

Background: Multimorbidity and polypharmacy are very common in older adults in primary care. Ideally, general practitioners (GPs), should regularly review medication lists to identify inappropriate medication(s) and, where appropriate, deprescribe. However, it remains challenging to deprescribe given time constraints and few recommendations from guidelines. Further, patient related barriers and enablers to deprescribing have to be accounted for. The aim of this study was to identify barriers and enablers to deprescribing as reported by older adults with polypharmacy and multimorbidity.

Methods: We conducted a survey among participants aged ≥70 years, with multimorbidity (≥3 chronic conditions) and polypharmacy (≥5 chronic medications). We invited Swiss GPs, to recruit eligible patients who then completed a paper-based survey on demographics, medications and chronic conditions. We used the revised Patients' Attitudes Towards Deprescribing (rPATD) questionnaire and added twelve additional Likert scale questions and two open-ended questions to assess barriers and enablers towards deprescribing, which we coded and categorized into meaningful themes.

Result: Sixty four Swiss GPs consented to recruit 5-6 patients each and returned 300 participant responses. Participants were 79.1 years (SD 5.7), 47% female, 34% lived alone, and 86% managed their medications themselves. Sixty-seven percent of participants took 5-9 regular medicines and 24% took ≥10 medicines. The majority of participants (77%) were willing to deprescribe one or more of their medicines if their doctor said it was possible. There was no association with sex, age or the number of medicines and willingness to deprescribe. After adjustment for baseline characteristics, there was a strong positive association between willingness to deprescribe and saying that because they have a good relationship with their GP, they would feel that deprescribing was safe OR 11.3 (95% CI: 4.64-27.3) and agreeing that they would be willing to deprescribe if new studies showed an avoidable risk OR 8.0 (95% CI 3.79-16.9). From the open questions, the most mentioned barriers towards deprescribing were patients feeling well on their current medicines and being convinced that they need all their medicines.

Conclusions: Most older adults with polypharmacy are willing to deprescribe. GPs may be able to increase deprescribing by building trust with their patients and communicating evidence about the risks of medication use.

Keywords: Deprescribing; General practice; Multimorbidity; Older adults; Patient attitudes; Polypharmacy.

Fig. 1

Flow chart of study participants

Fig. 2

Enabler, barrier and involvement items, sorted by proportion of patients agreeing with questions per domain; Legend: Enabler, barrier and involvement items from questionnaire, agreed or strongly agreed on (coloured part of the bar) versus unsure, disagreed, strongly disagreed on (grey part of the bar) by patients with multimorbidity and polypharmacy. Items are sorted by proportion of patients agreeing with questions per domain. * from rPATD

Fig. 3

Significant enablers and barriers towards the willingness to deprescribe in a forest plot; Legend: Significant barriers and enablers towards the willingness to deprescribe. Odds ratios from a multivariable mixed-effects logistic regression model adjusted for age, sex, education level, number of medicines, living status, medication self management and GP as random-effect. OR sorted by point estimate (top-down); * from rPATD